OHSU paper shows increase in colorectal cancer testing for Medicaid patients following Oregon’s coordinated care reforms, Medicaid expansion

01/24/19  Portland, Ore.

Researcher Melinda Davis, CHSE team find the 2014 statewide testing rate was 3.4 percent higher than in 2010

Melinda Davis

Changes in Oregon’s Medicaid delivery system were associated not only with a small uptick in colorectal cancer (CRC) testing overall, but also with shifts in modes of testing – for example, an increase in fecal testing, a less-invasive test than colonoscopy -- following CCO formation.

These results were reported in a paper led by Melinda Davis, Associate Professor and Director of Community Engaged Research for the Oregon Rural Practice-based Research Network, published this month in BMC Health Services Research.

Davis and her team, including several CHSE analysts, were especially interested in investigating the testing modalities promoted by different CCOs to increase CRC screening rates. Previous research has suggested that use of fecal tests (which can be distributed by mail) in average-risk patients is an effective tool for increasing CRC screening in populations that experience cancer disparities (for example, Medicaid beneficiaries, Latinos, and rural residents).  

“Our team had observed variation in the interventions that were being implemented across Oregon’s CCOs to increase CRC screening, and we were interested in both the general impact of these interventions on overall CRC screening rates across Oregon, as well as if and how these patterns varied by individual CCO,” says Davis. 

Data used for the study (administrative claims and enrollment data for Medicaid) suggested an uptick in CRC testing following CCO formation, “which was partially driven by an increase in use of fecal tests,” says Davis.  

“When you looked at the data by individual CCO, it suggests that the trend for increased fecal testing was primarily driven by a few CCOs,” she says. Qualitative data indicated that many of these same CCOs were implementing direct-mail fecal testing programs.

The research team used a retrospective analysis of Oregon’s Medicaid claims for Medicaid beneficiaries eligible for CRC screening from 2010-2014 as a method of investigation. The analysis explored the yearly probability of patients receiving CRC testing and the type of modality used to do the testing, specifically getting a colonoscopy, or completing a Fecal Immunochemical Test (FIT) or Fecal Occult Blood Test (FOBT), relative to a baseline year, which was January 2010. 

The analysis looked at individuals aged 50-64, and a total of 132,424 Medicaid enrollees met inclusion criteria for the study.  

CRC is the third leading cause of cancer-related deaths nationally and the second leading cause in Oregon. Symptoms of CRC may include changes in bowel movements, rectal bleeding, weakness, and unintended weight loss. However, patients in the early stages of CRC may not show signs (which is why screening is so important).

When CRC is detected early, the five-year survival rate is 90%. But, research suggests that only 63% of age-eligible adults in the United States are up-to-date with screening. Disparities in CRC screening are prominently observed within rural areas, and with adults who may have limited education or lower incomes, or who are enrolled in Medicaid insurance. 

If you’re interested in learning more about the various CRC screening options or interventions to increase fecal testing, check these other research articles by Davis and colleagues: “Finding the Right FIT” and "A systematic review of clinic and community interventions to increase fecal testing for CRC in rural and low-income populations.”